11210 research outputs found
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Angiotensin-neprilysin inhibition in acute decompensated heart failure: A meta-analysis of randomized controlled trials
No full textBackground: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.
Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.
Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p \u3c 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p \u3c 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024).
Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk
Heterogeneity in HeartMate 3 implanting center infection management reveals opportunities for quality improvement and best practice initiatives during left ventricular assist device support
No full textBackground: There is marked variability in device-related (DR) infection frequencies across HeartMate 3 (HM3) centers.
Objectives: The goal is to correlate center driveline (DL) management and infection mitigation practices with DR-infection development, laying foundation for development of best practice recommendations for one facet of HM3 patient care.
Methods: Coordinators at 30 HM3 centers were surveyed about center practices for infection prophylaxis, intraoperative DL placement and postoperative care, and infection mitigation. Early (≤90 days) and late (\u3e90 day) center DR-infection frequencies were calculated from Society of Thoracic Surgeons Intermacs data linkage. Correlations between center practice patterns and incident DR-infection were examined with multivariable Cox modelling (clustering adjusted hazard ratio (aHR)).
Results: Within Intermacs (3725 patients), 1-year freedom from DR-infection was 87% (80.6-87.3%). Initially, DL dressing changes were performed daily, weekly, and variably at 48%, 21% and 31% of centers. After 4 weeks, 57% deescalated dressing changes to weekly. Chlorhexidine cleanser with a silver-impregnated dressing (Chl-Sil) was standard at 52.7% of programs; 47.3% used chlorhexidine alone or other supplies. Use of Chl-Sil was associated with reduced early (aHR 0.48, p=0.004) and late (aHR 0.64, p=0.02) DR-infection while frequent dressing changes conferred higher late DR-infection (aHR 1.4 p=0.05). Antibiotic prophylaxis, DL tunneling, and diabetes practices did not correlate with DR-infection.
Conclusions: Given the burden of DR-infections, best practice recommendations are needed to standardize care. Application of Chl-Sil DL dressings could be a first step in achieving care standardization, while frequent dressing changes following DL incorporation should be avoided
The scope of vascular surgery expertise in pediatric surgery: A survey of division chiefs at United States children\u27s hospitals
No full textPurpose: Pediatric vascular diseases comprise a spectrum of acquired and congenital diagnoses; treatment is variable. Changing training paradigms have decreased general surgery exposure to vascular surgery. This nationwide survey aims to characterize the breadth of needs and practice patterns in pediatric vascular surgical management.
Methods: An electronic survey about pediatric vascular surgery practice patterns and resource utilization was delivered to pediatric surgery division chiefs or their proxies at children\u27s hospitals throughout the United States.
Results: The survey completion rate was 76% (138/182), including 85% of the 54 pediatric surgery fellowship programs and 61% of the 81 free-standing children\u27s hospitals. For ECMO cannulations, most divisions (90%) did not usually consult adult vascular surgeons. Regarding vascular surgeon hospital access, 79% had routine privileges, and 89% had electronic medical record access for billing consultations. Only 7.9% of respondents believed that pediatric vascular surgery should remain in the hands of pediatric surgeons only; there was a recurrent belief that the standard pediatric surgeon armamentarium lacks adequate vascular expertise. Common indications for adult vascular surgery consultation were major vascular injury and reconstruction, endovascular techniques, and complex oncological cases. Other factors included availability, the adult vascular surgeon\u27s willingness to operate on small children, and geography. Being joined/adjacent to an adult hospital appeared to facilitate vascular surgery consultation.
Conclusion: Surgical management of pediatric vascular disease is complex and may benefit from collaboration across specialties. There remains diversity in practice patterns nationwide and further work is needed to ensure optimal outcomes in this evolving group of patients
Bridging the gap between evidence and practice: Nationwide retrospective analysis of lipid-modifying therapy prescription patterns in 5 million patients with type 2 diabetes mellitus
No full textIntroduction: Type 2 diabetes mellitus (T2DM) is associated with dyslipidemia and significantly increased cardiovascular risk, making lipid-modifying therapy a crucial preventive intervention in these patients. Despite clear guidelines recommending statin therapy for both primary and secondary prevention, real-world prescription routines and practices show gaps in clinical care. We aimed to evaluate the rates and patterns of lipid-modifying therapy under prescription among T2DM patients across U.S. healthcare facilities.
Methods: We conducted a retrospective observational analysis using the TriNetX US Collaborative Network database, including data from 69 healthcare organizations throughout the United States. Patients with T2DM patients aged 40-75 years were included in our cohort. Under-prescription rates were calculated and analyzed across demographic subgroups using standardized protocols within the TriNetX platform.
Results: Among 5,007,910 T2DM patients, we observed significant statin under-prescription rates. Our analysis showed a prescription rate of 55.1% for statins in eligible patients with T2DM.
Conclusions: Our findings revealed a significant under-prescription of lipid-modifying therapy in T2DM patients. The universal nature of under-prescription suggests barriers to guideline implementation. These results underscore the urgent need for systematic interventions, including automated identification systems, standardized protocols, and optimized provider education to improve cardiovascular risk management in patients with T2DM
Post-approval study 3-year outcomes of the Neuroform Atlas stent for the treatment of wide-necked intracranial aneurysms
No full textINTRODUCTION: The ATLAS trial was a prospective, multicenter, single-arm, investigational device exemption (IDE) study to evaluate the safety and effectiveness of the Neuroform Atlas Stent System for the treatment of wide-necked bifurcation aneurysms. This analysis presents the 36-month follow-up data for the anterior and posterior cohorts. METHODS: Of the 182 patients in the IDE anterior cohort, 146 consented to participate in the post-approval study (PAS) and, of the 116 patients in the IDE posterior cohort, 101 consented to participate in the PAS. The primary effectiveness endpoint was core laboratory adjudicated (Raymond-Roy 1; RR1) without retreatment or parent artery stenosis (\u3e50%) at 36 months post-procedure. The primary safety endpoint was Clinical Event Committee-adjudicated major ipsilateral stroke or neurological death through 36 months. RESULTS: There were 146 patients in the anterior cohort and 101 patients in the posterior cohort. At 24 months the composite effectiveness endpoint was 77.3% (34/44) in the anterior cohort and 65.5% (19/29) in the posterior cohort and at 36 months these rates were 92.3% (24/26) and 75.0% (18/24), respectively. RR1 rates at 24 months were 84.1% (37/44) in the anterior cohort and 70.0% (21/30) in the posterior cohort; at 36 months they were 96.3% (26/27) and 79.2% (19/24), respectively. By 36 months the primary safety endpoint occurred in 4.1% (6/146) of patients in the anterior cohort and 5.0% (5/101) in the posterior cohort. CONCLUSION: The results of the long-term assessment of the Neuroform Atlas Stent System demonstrate favorable safety and effectiveness in the treatment of wide-necked bifurcation aneurysms without a single treated target aneurysm rupture beyond 12 months post-procedure
Inside Aurora Sinai Medical Center, 2004 August
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2264/thumbnail.jp
Inside Aurora Sinai Medical Center, 2004 February
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2258/thumbnail.jp
Robotic assisted bronchoscopy for peripheral pulmonary nodules - data review
No full textPurpose of review: Robotic Assisted bronchoscopy has emerged as an important tool in diagnosing small peripheral lung nodules in the era of CT screening. This paper reviews results from recent publications.
Recent findings: Three meta -analyses have now been reported. Diagnostic yields reported in studies must be considered in terms of the study prevalence of malignancy, which if high tends to give higher overall diagnostic yield. Diagnostic yields are consistently an improvement on earlier technologies, particularly for lesions
Summary: Ongoing clinical study with robotic nodule biopsy will continue given the significant advance it has provided to clinicians in the first 5 years of its introduction
